Psoriasis overview

Psoriasis overview

Readers unfamiliar with psoriasis may find this overview useful.
Psoriasis is a disorder of the skin and nails, characterized by inflammation and abnormal reproduction of skin cells. It can also affect joints and other tissues. The disease produces areas of thickened, scaly, silvery-white and reddened skin; discolored, crumbling, deformed, or uplifted nails; and arthritic symptoms in joints.
Approximately 2-3% of the population develop psoriasis. Two types of psoriasis are recognized: Type 1 strikes before age 40 and is generally found in other family members, type 2 strikes after age 40.
At present there is no cure for psoriasis, but patients typically experience periods of exacerbation and remission.
A common attitude among non-sufferers of psoriasis is that it is a ‘merely cosmetic’ condition and therefore not worth spending research funds on. The truth is that the cosmetic aspects alone are serious enough to drive some patients to suicide, and the arthritic aspects can be debilitating. Furthermore, research into psoriasis adds to our basic understanding of molecular and cell biology, which inevitably improves our understanding of other ailments.
The causes of psoriasis
Psoriasis is only partly understood. Recent research indicates that the disease is driven by activated immune cells called ‘T-cells’ (or ‘antigen-presenting cells’). These cells are involved in the recognition of foreign materials (such as viruses); when they find such a material, they communicate this information to other immune system cells by producing signalling molecules called ‘cytokines’. However, some of these cytokines can induce excessive reproduction of skin cells and cause them to develop abnormally. And some of the cytokines cause inflammation and its consequences: swelling, pain, redness, and heat.
This is the essence of the disease, but the process is extremely complex and not all of the signalling molecules and growth factors involved have been identified. Important questions remain unanswered: Do genetic factors account for why some people develop psoriasis while others don’t? Why do most people get psoriasis later in life and not earlier? Does something trigger the T-cells to release inappropriate combinations of signalling molecules? If so, what is this trigger?
Recent studies suggest that the microorganism Malassezia furfur may play a role in promoting psoriasis.
Inflammation — the non-explanation
Psoriasis and many other ailments are often attributed to ‘inflammation’. But what does this word actually mean, and is it a useful explanation for anything?
Traditionally, physicians used the word ‘inflammation’ for any condition in which four characteristics were present: redness, heat, swelling, and pain. The word gave no hint of the mechanisms responsible for these characteristics, because the medical world at that time had no knowledge of molecular biology.
In recent decades the molecular mechanisms involved in inflammation have been coming to light. They are extremely complicated, and involve cytokine signalling between different types of immune cells, the release of free radicals, dilation of blood vessels (which causes redness and heat), increase in permeability of capillaries (which causes swelling), and pressure on nerve endings (which causes pain).
The word ‘inflammation’ is still a convenient word for this collection of processes. But it is almost useless as an explanation for anything. For example, if someone says “Psoriasis is caused by chronic inflammation in the skin,” they are telling you nearly nothing, whereas if they say “Psoriasis is caused by abnormal releases of ‘Transforming Growth Factor-alpha’ in the skin,” then they are giving you at least a partial explanation of what is going on.
Treatments for psoriasis
In what follows, I will list both drugs and supplements that have anti-psoriatic properties or potential. The drugs will receive only brief mention — the main focus of this article is supplements, since they can be obtained without interference from government or medical professionals. I will give special attention to supplements that promote the body’s production of a cytokine called ‘interleukin-10’ (‘IL-10’), since IL-10 seems to hold special promise for suppressing psoriasis.
Some treatments for psoriasis date back 100 years or more. These include:
coal tar
anthralin (a cell-growth inhibitor, now called ‘dithranol’)
These topical treatments, although beneficial in many cases, are very messy to use, and harmful if applied carelessly. They have largely been abandoned in the industrialized world, where unstained clothes are highly valued. We won’t discuss them further here.
Corticosteroid drugs:

cortisone
hydrocortisone
clobetasol
halobetasol
betamethasone
diflorasone
Most of these are prescription drugs that are quite effective in suppressing proriatic lesions in some people in the earlier stages of the disease. But their side effects can be serious, and include thinning of the skin, dilated blood vessels, bruising, and skin color changes.
Anti-inflammatories:

Aspirin
NSAIDs (‘Non-Steroidal Anti-Inflammatory Drugs’)
Monoclonal antibodies and fusion proteins
Aspirin and NSAIDs are of more use in treating psoriatic arthritis than in treating psoriatic skin lesions. Antibodies and fusion proteins can prevent progression of joint destruction, but are very expensive. Since they are officially (and arbitrarily) classified as ‘drugs’ rather than ‘supplements’, we won’t deal further with these substances here.
Immune-suppressive drugs:

methotrexate
cyclosporine
These prescription drugs are used for severe and recalcitrant psoriasis. They require careful monitoring and can expose patients to increased risk of infections.
Retinoid drugs:

vitamin A
tretinoin
adapalene
tazarotene
Retinoids are substances that regulate the development of cells into specific cell-types, and that have anti-inflammatory activity. The doses of vitamin A required for anti-psoriatic effects are very high and cause unacceptable side effects. The other retinoids in the above list have been used with some success in treating psoriasis, but since these are prescription drugs, not supplements, they are outside of the scope of this article.
Estrogens:

Estrogens suppress inflammation, increase IL-10, enhance collagen synthesis, maintain skin moisture, and accelerate cutaneous wound healing by regulating the production of growth factors. It has therefore been suggested that estrogens might have value as psoriasis treatments. On the other hand, there is evidence that estrogens can exacerbate psoriasis. In the absence of clinical trials to determine the truth of the matter, the issue is unresolved.
Vitamin D compounds:

calcitriol (1,25-Dihydroxyvitamin D3, 1alpha,25-dihydroxycholecalciferol)
calcipotriene
Vitamin D3 and its analogs are steroid hormones that have complex effects on the mix of cytokines produced by target cells. Some of these compounds, such as calcitriol, are stimulators of IL-10 production and suppressors of inflammatory cytokines; these are therefore potential treatments for psoriasis. They will be dealt with later in this article.
Calcipotriene is a ‘designer’ form of vitamin D — it is therefore a drug rather than a supplement. This substance has also been shown to increase IL-10 production. A clinical trial in 1998 showed its efficacy as a psoriasis treatment.
Antioxidants:

N-acetyl cysteine (NAC)
Alpha-lipoic acid
Curcumin
Pine bark extract
EGCG (epigallocatchin gallate, from green tea)
Unusually high levels of oxidants and insufficient antioxidant activity have been found in psoriatic lesions, suggesting that excessive free radical activity might play a role in causing and maintaining the lesions, and that antioxidants might ameliorate this condition.
The search for appropriate antioxidants, however, is complicated by the fact that antioxidants are cell-specific in their actions — a given antioxidant may cause the production of different sets of cytokines in different cell types, and these cytokines will then have differing effects on the production of growth factors and therefore on cell growth. For example, the green tea antioxidant ‘EGCG’ promotes the production of the cytokine IL-10 in white blood cells, but inhibits IL-10 production in certain skin cells. Whether the net effect of such an antioxidant would be beneficial or counterproductive can only be determined by clinical studies.
Unfortunately, only a handful of clinical studies have tested antioxidants as psoriasis treatments. The above list of antioxidants is therefore offered merely on general principles as potential psoriasis therapies.
Cell-growth inhibitors:

Curcumin
Green tea catechins, such as EGCG (epigallocatchin gallate)
Resveratrol
Wild bilberry extract
Blueberry extract
Baicalein (from Scutellaria baicalensis)
and many others
Since psoriasis is characterized by abnormally fast reproduction and growth of skin cells, cell growth inhibitors are naturally of interest as treatments. Furthermore, psoriatic tissue seems to require excessive growth of capillaries and small blood vessels; inhibitors of blood vessel growth (‘angiogenesis inhibitors’) are therefore also of interest. The above list includes only a few of the many plant-derived cell growth inhibitors that have been revealed by tissue culture experiments. A few of them have been tested in vivo.
The best studied of these cell-growth inhibitors are resveratrol, green tea catechins, and curcumin. All three of these substances have problems, however. Resveratrol is easily degraded by air, light, and temperature, and most of the resveratrol supplements on the market are of poor quality by the time they reach the end-user. Green tea catechins, although anti-inflammatory in some tissues, are pro-inflammatory in others. Curcumin at high concentrations is a cell growth inhibitor, but at low concentrations it is a cell growth promoter — in cell culture experiments, at least. Since curcumin is poorly absorbed from the digestive tract, large doses may be required if it were used orally to inhibit cell growth.
These problems suggest that one would more likely get good results for psoriasis if the substances were used topically rather than orally. A compounding pharmacy could make a cream or ointment containing curcumin and/or tea catechins. (If a good source of resveratrol can be identified, it could be included as well.) One should bear in mind, however, that some of these substances will stain clothes.
Studies funded by a manufacturer of blueberry and bilberry extracts have shown them to be angiogenesis inhibitors. These extracts are highly colored and will undoubtedly stain clothes when used topically. Unfortunately they are very poorly absorbed when used orally; therefore, large doses are required.
Omega-3 fatty acids:

Fish oil
Eicosapentaenoic acid
Docosahexaenoic acid
Evening primrose oil
Linolenic acid (not linoleic acid)
Omega-3 fatty acids have immune-modulating effects that can be exploited to prevent or suppress psoriasis. These effects are brought about by modulation of the type and amount of cytokines produced by immune cells, by altering gene expression, and by lowering the ability of certain enzymes to produce inflammatory substances. The omega-3 fatty acids in fish oils — eicosapentanoic acid (EPA) and docosahexenoic acid (DHA) — appear to be much more effective than those in plants. Since these substances are sold as oils (i.e., as triglycerides) rather than as free acids, one must use them orally so that the free acids can be released by lipase enzymes in the digestive tract.
Probiotics:

Lactobacillus or Bifidobacterium supplements
Probiotics contain ‘beneficial bacteria’ that have been shown to reduce inflammation for a variety of diseases. They seem to work by modifying the body’s production of certain T-cells.
Avoidance therapies:

Smoking avoidance
Gluten avoidance
Androgen avoidance
Smoking is a known promoter of psoriasis.
Gluten, a substance found in wheat, oats, rye, barley, and millet, promotes psoriasis in some people — namely, those who have IgA and/or IgG antibodies to gliadin (a component of gluten).
Androgens tend to promote inflammation and may exacerbate psoriatic symptoms.
Other psoriasis treatments:

Salicylic acid
zinc pyrithione cream or lotion (DermaZinc)
melatonin
Salicylic acid is a widely used non-prescription treatment for many skin disorders. It acts as a softener of dead, hardened skin cells — it probably does not have any activity against the causes of psoriasis.
Zinc pyrithione is an anti-fungal drug available without prescription. Microorganisms such as Malassezia furfur are known to be involved in other skin conditions such as seborrheic dermatitis, and are likely to be involved in psoriasis, as well. Although this substance is not a nutritional supplement, it appears to be an important adjunct to other psoriasis treatments. I will therefore include it in the list of promising remedies given in the Amounts section below.
Melatonin levels in the blood of psoriasis patients lack the nocturnal peak that they have in non-psoriatics. Some patients therefore supplement with melatonin at bedtime. No formal clinical studies have evaluated this treatment.
Skin-Cap and the blundering bureaucracies
Skin-Cap was a topical psoriasis product from Spain that took the psoriasis world by storm in the mid-1990s because of its remarkable effectiveness. The product’s manufacturer, Cheminova International, claimed that the product’s active ingredient was zinc pyrithione, but the truth was that the product also contained a corticosteroid, clobetasol propionate. Government drug agencies all over the world therefore banned Skin-Cap, thereby making it unavailable to the entire psoriasis community and infuriating many users for whom it had been the only treatment that had ever worked.
It is interesting to note that several months before the disovery that Skin-Cap contained clobetasol, the distributors of Skin-Cap in the U.S. had been ordered by the Food and Drug Administration to stop selling it — not because the FDA deemed it dangerous or ineffective, but because it was being sold to treat psoriasis and other skin disorders. A psoriasis product that ostensibly contained only zinc pyrithione, a supplement, could be sold in the U.S. only if the seller abstains from telling the buyer what it is to be used for. The fact that Skin-Cap was the most effective psoriasis treatment ever seen did not matter a whit — the FDA’s regulations are designed to keep the bureaucrats in control, not to bring effective treatments to the public.
Once clobetasol was found in Skin-Cap, however, the product’s fate was sealed. It was soon banned; users were warned not to use it and were told to send their remaining Skin-Cap back to the seller at their own expense. Many refused, of course, and there is still a small amount of the product in circulation. Many newer products are being sold on the Internet claiming to be Skin-Cap. Most are zinc pyrithione without any corticosteroid, but some do contain other corticosteroids. The particular combination of ingredients in the original Skin-Cap were far more effective than any of the ingredients used separately.
New concept: the interleukin-10 connection
Interleukins are the signalling molecules (‘cytokines’) that are used by white blood cells for communication. The human immune system makes use of several dozen different interleukins, each conveying different information and causing different actions on target cells.
Interleukin-10 (IL-10) is a cytokine that limits or terminates inflammatory responses and helps to regulate the formation and proliferation of several kinds of immune cells, including T-cells. (Reminder: Badly regulated T-cells are considered to be leading actors on the psoriatic stage.) One of the mechanisms involved is IL-10 suppressing the production of pro-inflammatory cytokines, such as IL-1, IL-6, and IL-8.
More than ten years ago researchers discovered that psoriatic skin contains significantly less IL-10 than does normal skin. This suggested that psoriasis might be treated by raising IL-10 levels in the skin. From 1998 to 2002 several clinical trials were carried out to test this concept. It was found that IL-10 therapy caused a marked regression of the lesions, decreased the incidence of relapse, and prolonged the disease-free interval. But it became apparent that this approach was impractical — Interleukin-10 is a polypeptide and is expensive to make. It would be ineffective if taken orally or used topically (i.e., as a cream or lotion) and would therefore have to be injected repeatedly into each affected area of skin.
The next step should have been obvious: search for substances that can be used topically or orally and that indirectly cause a rise in IL-10 production by the cells in psoriatic skin that are under-producing it. With today’s research tools it is possible to screen thousands of chemicals simultaneously for their effects on IL-10 production — chemicals from plants, from animals, and from existing chemical archives. So… with at least three years to develop a list of good IL-10 inducers, we should by now have many clinical trials in progress testing these inducers on psoriatic patients, right? Readers will probably not be surprised to learn that no such search has been reported in the medical literature, no list has been developed, and no such clinical trials are in progress. Such is the state of medical research in today’s government-regulated world.
Nevertheless, just by searching on the Internet you and I can identify a few such compounds that have turned up during research studies not necessarily directed at psoriasis. These are:
N-acetyl cysteine (NAC)
Vitamin D3 (cholecalciferol), and its analogs (e.g., calcitriol, calcipotriene)
Baicalein (from Scutellaria baicalensis root, ‘Baikal Skullcap’)
Silibinin (from Silybum marianum, ‘Milk Thistle’)
EGCG (epigallocatechin gallate, from green tea)?
Whether green tea, and its principal active constituent EGCG, belong on this list of IL-10 promoters is debatable. In some studies, in certain cell types, EGCG promotes IL-10 production. In other studies, in other cell types, it inhibits IL-10 production. The lack of actual clinical data on the use of EGCG for treating psoriasis means that if psoriasis patients want to know what EGCG does to psoriatic lesions, they will have to try it themselves.
One supplement to avoid (with respect to its effects on IL-10, that is) is
Genistein
Genistein has been shown to inhibit IL-10 production.
Amounts required for anti-psoriatic effects
How much of each of the supplements discussed in this article would one have to use in order to achieve anti-psoriatic effects? Since the clinical trials that would answer this question have not been done for most of these substances, the answers I give here are just educated guesses. Furthermore, there is a significant possibility that some of these compounds, if used orally, could have harmful interactions with other substances already being used by patients. On the other hand, certain combinations of these and other substances are likely to be better treatments than the substances used by themselves; identifying these combinations, however, will require a lot of experimentation — far more than is currently being done by the medical research establishment.
Generally speaking, it makes more sense to treat psoriasis by using a substance topically rather than orally, since smaller amounts of the substance are needed, and they are less likely to affect the whole body. In some cases topical use may be impractical: for example, the omega-3 oils may be too messy to use this way — but these are beneficial for the whole body in any case.
Most of the substances listed below are available as oral supplements but usually not in forms that can be used topically. Topical formulations can be made by a compounding pharmacy, or even by non-professionals if they can get the active ingredients. It pays to ‘shop around’ for compounding pharmacies, since the prices charged for the same product can vary enormously.
Calcitriol (aka ‘1,25-Dihydroxyvitamin D3’, or ‘1alpha,25-dihydroxycholecalciferol’) — 3 microgram/gram ointment applied in the evening.
N-acetyl cysteine (NAC) — topical: 10% cream applied twice daily
Alpha-lipoic acid — topical: 5% cream applied twice daily; oral: 250 mg twice per day
Curcumin — topical: 2% cream (likely to stain clothes); oral: 333 mg three times/day plus 10 mg piperine to improve absorption
Pine bark extract — oral: 100 mg proanthocyanins per day
EGCG (epigallocatchin gallate, from green tea) — oral: 800 mg/day?
Wild bilberry or blueberry extract (25% anthocyanidins) — oral: 120 mg twice per day with meals.
Fish oil, EPA, or DHA — oral: at least 4 g/day of combined EPA+DHA.
zinc pyrithione cream or lotion (DermaZinc) — as stated on the package.
melatonin — topical: 0.5% gel
Vitamin D3 (cholecalciferol) — topical: 0.005% ointment
Baicalein — topical: 0.07% cream or gel (calculated from in vitro data from prostate cell study)
Silibinin — topical: 10% cream or gel (based on photoprotection study in mice)
In conclusion
Certain nutritional supplements have great potential as psoriasis treatments, but have received very little attention from medical researchers. These supplements fall into several categories, which suggests the possibility of synergistic action between the substances in different categories. Although some of these supplements seem fairly expensive, their costs are miniscule compared to the costs of many prescription drugs — and many of the latter are not even especially effective.
A psoriasis patient who wants to try out some of the substances mentioned in this article should realize that he or she will be operating in largely uncharted territory. While self-experimentation is the only way to get answers to questions that mainstream medicine does not want to address, it carries certain risks that should be weighed against the risks of not self-experimenting. Is it better to try an untested treatment or to leave matters as they are? One has to judge that for oneself. While government bureaucrats and physicians’ groups are all-too-willing to tell you not to do it, I’m not as arrogant as they are — I suggest that you decide for yourself.
Discussion group
I’ve set up a discussion group at Yahoo Groups for those who want to exchange information, and share experiences about self-experimentation with psoriasis remedies, especially those based on supplements. The group will be lightly moderated to remove spam and prevent verbal attacks on members (‘flaming’, in other words).
To join, go to http://health.groups.yahoo.com/group/psori/. If you are not already registered with Yahoo, you will be guided through the registration process (which is free).
— Dr. Alexis Zarkov, Ph.D.
You can contact Dr. Zarkov at AskDrZarkov@yahoo.com.
Last modified 2005.Sep.13
References
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Inflammation

The inflammatory response in mild and in severe psoriasis. Br J Dermatol. 2004 May;150(5):917-28.
Tutorial on inflammation
Nutritional treatments

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Rainforest plant helps treat psoriasis [Dithranol]
Retinoids

[Treatment of psoriasis using vitamin A, vitamin A acid and oral retinoids] Hautarzt. 1979 Mar;30(3):124-33.
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Estrogens

Regulatory roles of sex hormones in cutaneous biology and immunology. J Dermatol Sci. 2005 Apr;38(1):1-7. Epub 2004 Dec 9.
Tamoxifen-induced remission of psoriasis. J Am Acad Dermatol. 1999 Nov;41(5 Pt 2):887-9.
Vitamin D

Use of vitamin D in the treatment of psoriasis — a historical analysis
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1,25-(OH)2-vitamin D3 and calcipotriol induce IL-10 receptor gene expression in human epidermal cells. Inflamm Res. 1997 Jan;46(1):32-4.
Immunoregulation by 1,25-dihydroxyvitamin D(3): Basic concepts. J Steroid Biochem Mol Biol. 2005 Jul 18
Calcitriol ointment and clobetasol propionate cream: a new regimen for the treatment of plaque psoriasis. Eur J Dermatol. 2003 May-Jun;13(3):261-5.
Antioxidants

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Plasma melatonin levels in psoriasis. Acta Derm Venereol. 1988;68(4):312-6.
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Suppression of UV-induced erythema by topical treatment with melatonin (N-acetyl-5-methoxytryptamine). A dose response study. Arch Dermatol Res. 1996 Aug;288(9):522-6.
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Pine bark extract pycnogenol downregulates IFN-gamma-induced adhesion of T cells to human keratinocytes by inhibiting inducible ICAM-1 expression. Free Radic Biol Med. 2000 Jan 15;28(2):219-27.
Flavonoids that mimic human ligands from the whole plants of Euphorbia lunulata. [Quercetin mimics IL-10.] Chem Pharm Bull (Tokyo). 2005 Mar;53(3):305-8.
Testing of lipoxygenase inhibitors, cyclooxygenase inhibitors, drugs with immunomodulating properties and some reference antipsoriatic drugs in the modified mouse tail test, an animal model of psoriasis. Skin Pharmacol. 1994;7(6):324-34.
[Selenium nutritional status and the course of psoriasis] Pol Merkuriusz Lek. 1999 May;6(35):263-5.
Antioxidant [N-acetyl cysteine] Useful For Dry Skin and Possibly Psoriasis
Topical N-acetylcysteine treatment in neonatal ichthyosis. Turk J Pediatr. 2003 Jul-Sep;45(3):245-7.
Alpha-Lipoic acid-based PPARgamma agonists for treating inflammatory skin diseases. Arch Dermatol Res. 2004 Aug;296(3):97-104. Epub 2004 Jun 24.
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Pharmacological activities of curcuma longa extracts U.S. patent # 6,841,177 January 11, 2005
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A single ascending dose study of epigallocatechin gallate in healthy volunteers. J Int Med Res. 2003 Mar-Apr;31(2):88-101.
Cell growth inhibitors

Nutraceuticals as anti-angiogenic agents: hopes and reality. J Physiol Pharmacol. 2005 Mar;56 Suppl 1:51-69.
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Baicalein and baicalin are potent inhibitors of angiogenesis: Inhibition of endothelial cell proliferation, migration and differentiation. Int J Cancer. 2003 Sep 10;106(4):559-65.
Characterization of chemical constituents in Scutellaria baicalensis with antiandrogenic and growth-inhibitory activities toward prostate carcinoma. Clin Cancer Res. 2005 May 15;11(10):3905-14.
Bioavailability of anthocyanidin-3-glucosides following consumption of red wine and red grape juice. Can J Physiol Pharmacol. 2003 May;81(5):423-35.
The influence of chokeberry juice supplementation on the reduction of oxidative stress resulting from an incremental rowing ergometer exercise. Int J Sport Nutr Exerc Metab. 2005 Feb;15(1):48-58.
Fatty acids

Polyunsaturated fatty acids and inflammatory diseases. Biomed Pharmacother. 2002 Oct;56(8):388-96.
Evening primrose oil and borage oil in rheumatologic conditions. Am J Clin Nutr. 2000 Jan;71(1 Suppl):352S-6S.
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Probiotics

Lactobacillus casei reduces CD8+ T cell-mediated skin inflammation. Eur J Immunol. 2004 Sep;34(9):2520-8.
Avoidance therapies

Psoriasis patients with antibodies to gliadin can be improved by a gluten-free diet Br J Dermatol. 2000 Jan;142(1):44-51.
Cutaneous Effects of Smoking. J Cutan Med Surg. 2005 Jul 7
Salicylic acid

Salicylic Acid (Topical) MedLine Plus
Skin-Cap and zinc pyrithione

The Skin-Cap story Dave's Psoriasis Info
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FDA WARNS CONSUMERS NOT TO USE SKIN-CAP
Psoriasis patients talk about Skin-Cap
Dermatologists talk about Skin-Cap
Interleukin-10

Interleukin-10 and Psoriasis
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Immunomodulation by interleukin-10 therapy decreases the incidence of relapse and prolongs the relapse-free interval in Psoriasis. J Invest Dermatol. 2002 Apr;118(4):672-7.
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GotClearSkin.com

Report on the Psycho-Social Impacts of Psoriasis Summary

National Psoriasis Foundation Report on the Psycho-Social Impacts of Psoriasis Summary

This report is the culmination of the largest longitudinal study to date of the psycho-social impacts of psoriasis on individuals.

Over a period of six years, the National Psoriasis Foundation collected responses to questions about the emotional and social effects of psoriatic diseases from nearly 5,000 people with
psoriasis and/or psoriatic arthritis.

The results of this study highlight sharp differences in the negative impact psoriasis has on various populations including women, minorities and young people. The National Psoriasis Foundation will use this information to design and deliver programs and services that continue to assist these populations in coping with and managing their condition.

Click the link below for the PDF / Report

http://www.psoriasis.org/NetCommunity/Document.Doc?id=619

Elorac, Inc. Announces Launch of Novel, Steroid-free, Prescription Cream for Psoriasis

Elorac, Inc. has announced the launch Zithranol™-RR (anthralin rapid release microcrystalline encapsulated cream, 1.2%) for the treatment of mild to moderate plaque psoriasis. Zithranol™-RR is available by prescription in a 45 gram tube

VERNON HILLS, Ill.--(EON: Enhanced Online News)--Now patients with mild to moderate plaque psoriasis have a new topical treatment option available by prescription. Zithranol™-RR (anthralin rapid release microcrystalline encapsulated cream, 1.2%), is an innovative topical therapy for plaque psoriasis according to Elorac, Inc., a privately held emerging dermatology company. Zithranol™-RR provides an advanced delivery system for anthralin achieving long remission times with no long-term side effects in a steroid-free, silky cream.

While there is no cure for psoriasis, treatment can clear psoriatic skin for periods of time. Zithranol™-RR contains the active ingredient anthralin which has been shown to clear psoriasis and keep it in remission for long periods of time with only once-a-day application.

“The key to Zithranol™-RR is the advanced delivery system designed to rapidly release anthralin allowing for excellent efficacy with only once daily application,” said Joel Bernstein, MD, a dermatologist and CEO of Elorac. “Zithranol™-RR makes it easy to utilize the known efficacy and safety of anthralin while minimizing the challenges commonly seen with traditional anthralin formulations.”

Zithranol™-RR’s advanced delivery of anthralin is designed to rapidly release anthralin to the psoriatic skin reducing the risk of staining and irritation seen with traditional formulations of anthralin. It is a 1.2% anthralin cream in which the active ingredient is surrounded by a protective layer of lipids. These layers melt at body temperature, releasing the anthralin only on the skin where it is applied, not on clothes, bedding or bathroom fixtures.

The unique, quick delivery of Zithranol™-RR is known as short contact anthralin therapy (S.C.A.T.). “A patient can apply Zithranol™-RR, have breakfast then rinse off the medication with cool or luke-warm water and be done with the treatment for the day,” said Dr. Bernstein.

Additional benefits to Zithranol™-RR include:

Long lasting efficacy with up to 6 months remission times
Convenient once daily, short-contact therapy
Proven safe with no long-term side effects
Rapid release delivery reduces irritation and staining
Zithranol™-RR is available by prescription. There are no branded or generic equivalents for Zithranol™-RR.

For full prescribing information and patient instructions regarding Zithranol™-RR, please visit www.eloracpharma.com.

About Zithranol™-RR’s Advanced Delivery of Anthralin

Zithranol™-RR contains 1.2% microcrystalline encapsulated anthralin in a green, aqueous cream. The anthralin in Zithranol™-RR is microencapsulated into a proprietary formulation of surface active crystalline polar lipids to provide for rapid release, as well as to reduce irritation and staining frequently observed with nonencapsulated anthralin preparations. Since Zithranol™-RR’s advanced delivery system rapidly releases anthralin into psoriatic plaques on contact with skin, Zithranol™-RR is especially useful for short contact (5-15 minutes) therapy with anthralin. Zithranol™-RR contains no preservatives.

About Elorac

Elorac, Inc. is a privately held pipeline and marketing pharmaceutical company engaged in the discovery and development of novel products for the management of skin disorders. Elorac owns or licenses the rights to over 20 novel treatments for various cutaneous diseases. The company is poised to launch unique prescription products representing potentially significant improvement over current therapies focusing exclusively on the management of skin disease.

About Psoriasis

Psoriasis is a non-contagious, chronic skin disease that affects between 5.8 and 7.5 million Americans according the National Institutes of Health (NIH). It usually appears as thick, red, scaly patches created by a rapid overgrowth of skin cells.

Contacts

Elorac, Inc.
Christopher Gabanski, 847-362-8200 ext. 238
Vice President Sales & Marketing
cgabanski@eloracpharma.com
www.eloracpharma.com

Permalink: http://eon.businesswire.com/news/eon/20090827005683/en

Diagnosing psoriatic arthritis: tests to confirm the diagnosis

Psoriatic arthritis
Diagnosing psoriatic arthritis: tests to confirm the diagnosis

A person with joint aches and pains should talk to a doctor about diagnosis and treatment. Primary-care doctors or dermatologists can treat psoriatic arthritis, but psoriatic arthritis patients should consider seeing a rheumatologist, a doctor who specializes in arthritis.

There is no definitive test for psoriatic arthritis. The diagnosis is made mostly on a clinical basis and by a process of elimination. Medical history, physical examination, blood tests, MRIs and X-rays of the joints that have symptoms may be used to diagnose psoriatic arthritis. It is important to communicate your history of psoriasis to your doctor.

The symptoms of psoriatic arthritis are similar to those of three other arthritic diseases: rheumatoid arthritis, gout and reactive arthritis. Rheumatoid arthritis generally involves joints symmetrically distributed on both sides of the body, and it may produce bumps under the skin that are not present in psoriatic arthritis. However, some forms of psoriatic arthritis look very similar. The simultaneous presence of psoriasis on the skin and nail changes supports a diagnosis of psoriatic arthritis.

A certain antibody, called a rheumatoid factor, is normally present in rheumatoid arthritis. The rheumatoid factor is not usually found in the blood of psoriatic arthritis patients. A blood test for that antibody may help distinguish between the two diseases. A person can have rheumatoid arthritis and psoriatic arthritis, but that is rare. Many of the treatments for psoriatic arthritis and rheumatoid arthritis overlap.

Likewise, it is possible to have gout along with psoriasis and psoriatic arthritis. If you have an excruciatingly painful attack in a joint, particularly in the big toe, you may want to have a test for gout. Fluid drawn from the affected joint is examined to resolve the diagnosis of gout or psoriatic arthritis. Psoriatic arthritis patients are commonly misdiagnosed as having gout, because they often have elevated serum uric acid levels, which also can be caused by taking low-dose aspirin or by increased skin cell turnover. It is important to distinguish between the two forms of arthritis, because they may be treated with different medications.

In the very early stages of the disease, X-rays usually do not reveal signs of arthritis and may not help in making a diagnosis. In the later stages, X-rays may show changes that are characteristic of psoriatic arthritis but not found with other types of arthritis, such as the "pencil in cup" phenomenon where the end of the bone gets whittled down to a sharp point. Changes in the peripheral joints and in the spine support the diagnosis of psoriatic arthritis. However, most of the changes occur in the later stages of the disease.

Frequently asked questions about psoriatic arthritis

Frequently asked questions about psoriatic arthritis

What is psoriatic arthritis?

Psoriatic arthritis [pronounced sore-ee-AA-tic] causes pain, stiffness and swelling in and around the joints and places where tendons and ligaments connect to bone. Without treatment, psoriatic arthritis can potentially be disabling.

What causes psoriatic arthritis?

Both genetic and environmental factors seem to be associated with the development of psoriatic arthritis. The immune system plays an important role. Psoriatic arthritis is linked to psoriasis on the skin; in 85 percent of individuals, skin disease preceded joint disease.

What are the symptoms of psoriatic arthritis?

Tender swollen joints
Swollen and tender entheses (where a muscle or ligament attaches to a bone)
Back pain
Nail changes—for example, a nail that separates from the nail bed and/or becomes pitted and mimics fungal infections
Morning stiffness and tiredness
Generalized fatigue
A reduced range of motion
Redness and pain of the tissues surrounding the eyes, such as conjunctivitis
How is psoriatic arthritis diagnosed?

There is no specific test for psoriatic arthritis. The diagnosis is based mostly on symptoms, examination, X-rays and the elimination of other types of arthritis. If you have psoriasis and experience persistent joint pain, you may have psoriatic arthritis and you should see a rheumatologist. These doctors specialize in arthritis and can provide further evaluation and/or a diagnosis.

Is all psoriatic arthritis the same?

No. There are considered to be five different forms of psoriatic arthritis:

Symmetric: Affects multiple symmetric pairs of joints (occurs in the same joints on both sides of the body).
Oligoarticular: Affects few joints in an asymmetric pattern and is usually milder.
Distal interphalangeal (DIP): Affects primarily the distal joints of the fingers and toes (the joints closest to the nail).
Spondylitis: Predominantly affects the spinal column from the neck to the lower back.
Arthritis mutilans: Affects the small joints of the hands and feet, although it can appear in other joints. This rare form of arthritis is severe and destructive.
What treatments are available for psoriatic arthritis?

Drugs for the treatment of psoriatic arthritis are divided into three main categories:

Nonsteroidal anti-inflammatory drugs (NSAIDs) include over-the-counter medications such as aspirin and ibuprofen as well as prescription products.
Disease-modifying antirheumatic drugs (DMARDs) may relieve more severe symptoms and attempt to slow or stop joint/tissue damage and the progression of psoriatic arthritis.
Biologics such as adalimumab, etanercept and infliximab are also considered DMARDs. They are highly selective agents that target specific parts of the immune system that cause psoriasis and psoriatic arthritis.

Psoriatic arthritis
Treating psoriatic arthritis

Treatment for psoriatic arthritis can relieve pain, reduce swelling, help keep joints working properly and possibly prevent further joint damage. Doctors will recommend treatments based on the type of psoriatic arthritis, its severity and an individual’s reaction to treatment.

Early diagnosis and treatment can help slow the disease and preserve function and range of motion. Some early indicators of severe disease include onset at a young age, having many joints involved and spinal involvement. Good control of the skin disease may be valuable in the management of psoriatic arthritis. Some treatments are approved to treat both psoriasis and psoriatic arthritis.

"Localized" mild psoriatic arthritis

Generally, localized psoriatic arthritis is mild and affects only one or two joints. A person may experience long periods with no symptoms. Psoriatic arthritis of this nature generally causes less deformity and long-term disability.

"Generalized" disabling psoriatic arthritis

A portion of people who have three or more affected joints may have a higher risk of joint destruction and disability. When it is not relieved by anti-inflammatory drugs, more potent medications may be required. Some cases may require surgery and rehabilitation.

Home versus outpatient ultraviolet B phototherapy.

Research

Home versus outpatient ultraviolet B phototherapy for mild to severe psoriasis: pragmatic multicentre randomised controlled non-inferiority trial (PLUTO study)

Mayke B G Koek, research fellow1, Erik Buskens, professor of medical technology assessment2,3, Huib van Weelden, investigator photodermatology1, Paul H A Steegmans, dermatologist4, Carla A F M Bruijnzeel-Koomen, professor of dermatology/allergology1, Vigfús Sigurdsson, dermatologist1

1 Department of Dermatology/Allergology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Netherlands, 2 Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands, 3 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands, 4 Department of Dermatology, St Antonius Hospital, Nieuwegein, Netherlands

Correspondence to: M B G Koek author@koek.com

Objective To determine whether ultraviolet B phototherapy at home is equally safe and equally effective as ultraviolet B phototherapy in an outpatient setting for patients with psoriasis.

Design Pragmatic multicentre single blind randomised clinical trial (PLUTO study).

Setting Dermatology departments of 14 hospitals in the Netherlands.

Participants 196 patients with psoriasis who were clinically eligible for narrowband (TL-01) ultraviolet B phototherapy. The first 105 consecutive patients were also followed for one year after therapy.

Intervention Ultraviolet B phototherapy at home using a TL-01 home phototherapy unit compared with standard narrowband ultraviolet B phototherapy in an outpatient setting. Both therapies were done in a setting reflecting routine daily practice in the Netherlands.

Main outcome measures The main outcome measure was effectiveness as measured by the proportion of patients with a 50% or more reduction of the baseline psoriasis area and severity index (PASI) or self administered psoriasis area and severity index (SAPASI), called the PASI 50 and SAPASI 50 (relevant treatment effect). Another outcome of effectiveness was the percentage reduction in median scores on the PASI as well as SAPASI. Also the proportions of patients reaching the PASI 75 and SAPASI 75 (successful treatment effect), and the PASI 90 and SAPASI 90 (almost complete clearance) were calculated. Other secondary outcomes were quality of life (SF-36, psoriasis disability index), burden of treatment (questionnaire), patients’ preferences and satisfaction (questionnaire), and dosimetry and short term side effects (diary).

Results 82% of the patients treated at home compared with 79% of the patients treated in an outpatient setting reached the SAPASI 50 (difference 2.8%, 95% confidence interval -8.6% to 14.2%), and 70% compared with 73% reached the PASI 50 (-2.3%, -15.7% to 11.1%). For patients treated at home the median SAPASI score decreased 82% (from 6.7 to 1.2) and the median PASI score decreased 74% (from 8.4 to 2.2), compared with 79% (from 7.0 to 1.4) and 70% (from 7.0 to 2.1) for patients treated in an outpatient setting. Treatment effect as defined by the mean decline in PASI and SAPASI scores was significant (P<0.001) and similar across groups (P>0.3). Total cumulative doses of ultraviolet B light were similar (51.5 v 46.1 J/cm2, difference 5.4, 95% confidence interval -5.2 to 16.0), and the occurrence of short term side effects did not differ. The burden of undergoing ultraviolet B phototherapy was significantly lower for patients treated at home (differences 1.23 to 3.01, all P 0.001). Quality of life increased equally regardless of treatment, but patients treated at home more often rated their experience with the therapy as “excellent” (42%, 38/90) compared with patients treated in the outpatient department (23%, 20/88; P=0.001).

Conclusion Ultraviolet B phototherapy administered at home is equally safe and equally effective, both clinically and for quality of life, as ultraviolet B phototherapy administered in an outpatient setting. Furthermore, ultraviolet B phototherapy at home resulted in a lower burden of treatment and led to greater patients’ satisfaction.

Source: http://www.bmj.com/cgi/content/abstract/338/may07_2/b1542

Today is World Psoriasis Day! Oct 29th, 2009

Source: www.psoriasis.org/wpd
Join Today: http://www.psoriasis.org 

NATIONAL PSORIASIS FOUNDATION Today is World Psoriasis Day, a global effort to raise public awareness about psoriasis and psoriatic arthritis and the seriousness of these diseases. Psoriasis—a noncontagious disease of the immune system that appears on the skin—affects approximately 125 million people worldwide. In the U.S., psoriasis is the most common autoimmune disease, affecting as many as 7.5 million people. Psoriasis is linked to other serious conditions, including heart disease, diabetes, liver disease and obesity. People with psoriasis and psoriatic arthritis report that their disease impacts their daily lives, shapes their feelings about themselves and affects how they believe others perceive them.

Take action for World Psoriasis Day! Find more information about World Psoriasis Day at www.psoriasis.org/wpd. Help find a cure for psoriasis.  Donate today!